JOMS study: Penicillin allergy testing encouraged to reduce infection risk in oral surgery patients

ROSEMONT, Ill. – Unsubstantiated, patient-reported penicillin allergies are a risk factor for surgical site infections (SSIs) after oral and maxillofacial surgery (OMS), according to a new study.

The study published in the January issue of the Journal of Oral and Maxillofacial Surgery – the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS) – suggests testing patients for a penicillin allergy before surgery to clarify decisions about antibiotic use that could result in a reduced risk of infection.

Beta-lactam antibiotics, such as penicillin, are considered the most effective agents in preventing infection after OMS procedures. When patients report penicillin allergies but do not have them, they receive other, less-effective antibiotics before the procedure, according to the research.

Penicillin allergy is one of the most common allergies reported by patients, the study notes. About 10 percent of patients say they have penicillin hypersensitivity, but 90 percent of the cases are not actual allergies, the study cites. Fewer than 1 percent of patients have true penicillin allergies, according to the CDC.

Penicillin and other beta-lactam antibiotics are often avoided in patients who report a penicillin allergy. The alternative to penicillin is other broad-spectrum antibiotics, such as clindamycin, which target a wide range of bacteria and are associated with toxicities and development of antibiotic resistance.

The study consisted of 2,058 patients, including 318 who reported a penicillin allergy. Those who reported a penicillin allergy were more likely to be prescribed clindamycin while those who did not report a penicillin allergy were more likely to be given beta-lactam antibiotics.

Clindamycin was associated with a four-fold increase in SSI rate compared to the beta-lactam antibiotics, including penicillin, the study found. According to other studies, clindamycin is associated with elevated SSI risk and development of antibiotic resistance. By reporting a penicillin allergy they do not have, non-allergic patients can be exposed to the higher risks of a non-penicillin antibiotic, the study indicates.

Therefore, researchers wrote, “Incorporating preoperative penicillin allergy testing into elective oral and maxillofacial surgery as a risk reduction method should be considered.”

The authors of “Is Penicillin Allergy a Risk Factor for Surgical Site Infection After Oral and Maxillofacial Surgery?” are Daniel M. Roistacher, DMD, from Mount Sinai Health System in New York, N.Y.; Joshua A. Heller and Nalton F. Ferraro, DMD, MD, from Harvard School of Dental Medicine in Boston, Mass.; and Meredith August, DMD, MD, from Massachusetts General Hospital in Boston.

The full article can be accessed at

The Journal of Oral and Maxillofacial Surgery is published by the American Association of Oral and Maxillofacial Surgeons to present to the dental and medical communities comprehensive coverage of new techniques, important developments and innovative ideas in oral and maxillofacial surgery. Practice-applicable articles help develop the methods used to handle dentoalveolar surgery, facial injuries and deformities, TMJ disorders, oral and head and neck cancer, jaw reconstruction, anesthesia and analgesia. The journal also includes specifics on new instruments and diagnostic equipment, and modern therapeutic drugs and devices.